Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1104887694 Individual Practitioner Male Practitioner

Fred Rezvani

Specialist • Ridgewood, NJ

Professional Overview & Biography Verified Profile Summary

Fred Rezvani is a registered healthcare professional specializing in Specialist in Ridgewood, NJ. Practice services are available at 119 PROSPECT ST under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

119 Prospect St
1st Floor Suite 1

Ridgewood, NJ 074504405

Telephone 2014441600
Fax 2014448774
Associated Practice Facility / Clinic
🏢 Healthcare 2000, Llc Facility NPI 1023056470

Specialty Benchmarks & Practice Insights

Comparative analytics for Specialist in Ridgewood, NJ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 41.5 Yrs
State Avg: 35.6 Yrs
Regional Practice Density
11 Specialists

Practicing in Ridgewood, NJ (1802 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-05-06
Specialist Primary Specialty

NUCC Taxonomy Code: 174400000X

State License NJ 25MA05115800

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Empire Bc/bs Of Ny
30G161 (NJ)
Commercial Insurance / Payer ID Aetna Ppo #
4226530 (NJ)
Commercial Insurance / Payer ID Healthnet #
0K6927 (NJ)
Commercial Insurance / Payer ID Oxford Id#
BP204 (NJ)
Commercial Insurance / Payer ID Amerihealth #
0562861001 (NJ)
Commercial Insurance / Payer ID Aetna Hmo #
0028398 (NJ)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1245515527

Doctor of Dental Surgery

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location May 06, 2025

Registered at 119 PROSPECT ST, 1ST FLOOR SUITE 1, RIDGEWOOD, NJ 074504405 (Tel: 2014441600)

📍
Updated Business Mailing Address May 06, 2025

Registered at 119 PROSPECT ST, 1ST FLOOR SUITE 1, RIDGEWOOD, NJ 074504405 (Tel: 2014441600)

NPI Profile Active April 16, 2008

NPI status registered as active in NPPES database

📍
Updated Practice Location April 16, 2008

Registered at 119 PROSPECT ST, RIDGEWOOD, NJ 074504405 (Tel: 2014441600)

📍
Updated Business Mailing Address April 16, 2008

Registered at 119 PROSPECT ST, RIDGEWOOD, NJ 074504405 (Tel: 2014441600)

👤
Provider Name / Credentials Updated April 16, 2008

Recorded as FRED REZVANI

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 16, 2008

Specialist (License #25MA05115800 in NJ)

🟢
Initial NPI Registration & Enumeration April 01, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1104887694
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 01, 2006
Last Update: May 06, 2025
Sole Proprietor: No

Mailing Address

119 Prospect St, 1st Floor Suite 1

Ridgewood, NJ 074504405

Phone: 2014441600

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.